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The Contribution of the General Practitioner to Undergraduate Medical Education

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The Contribution of the General Practitioner to Undergraduate Medical Education The Contribution of the General Practitioner to Undergraduate Medical Education A Statement by the working party appointed by the second European Conference on the Teaching of General Practice (Leeuwenhorst Netherlands 1974) May 1977 Summary This statement is about the education of all future doctors. It discusses: 1. The place of the general practitioner in medical care. 2. The meaning of basic medical education. 3. The reasons why a contribution from general practice is needed in the basic education of all doctors. 4. The nature of the contribution, in outline and in detail. This is presented as a range of content from which any medical school can choose. 5. The way in which this contribution differs from the content of specific postgraduate preparation for general practice. There are seven reasons why undergraduate (basic) medical education must include a contribution from general practice: 1. Medical students need to see the way in which most people receive medical care for most of the time when they are in contact with medical services. 2. They need to see medicine in its most integrated form. 3. They need to see medicine centered as much or more on the person as on the "case" or on the use of highly technical means. 4. Students who will become general practitioners (the largest group) need an introduction to this branch which will be developed later in their specific training. Those who will enter other branches need experience of general practice, to which they may act as consultants. 5. Medical students need a chance to see general practice as one of many possible career choices. 6. General practitioners can provide the medical school with a new and very large resource for teaching and research. 7. General practice needs the stimulation which belongs to the teaching of medical students as much as does any other branch. Introduction This working party wrote a short statement in 1975 about The General Practitioner in Europe, containing a description of his work and broad educational aims for his training. The present report by the same working party examines undergraduate education for all doctors and the general practitioner's contribution to it. It therefore stands alongside the 1975 statement, part of which appears as Appendix 2, attached to the present document. The place of the general practitioner in medical care is fundamental. It has become clearer as specialisation and technology have increased and become more complex. His function and that of the specialist are complementary. Patients need a doctor with a broad range of understanding who is familiar to them; who can decide, together with the patient if medical care is needed; who is able to recognise and define their problems, and to deal with most himself: who will consult with a specialist as and when he considers this necessary, and will continue to be available until there is no further need, whether or not a specialist is also involved; who will be there again if a new need arises. Certain recent trends have reinforced the generalist's role in medicine. The cure of acute diseases (especially of infective diseases) has become not only more successful, but takes place more often outside hospital. The problems of caring for patients with chronic diseases have received more emphasis. They too largely receive their treatment outside hospital, often lead a relatively normal family and working life, and require continuity in long term care. The importance of emotional and social problems is better recognised, alike by doctors and patients. The preventive and educational aspects of medical care are seen to need increasing priority in relation to the curative aspects. The disadvantages of specialised have become more obvious - fragmentation, complexity, cost, and risk to the patient. In our previous statement we described the job of a general practitioner; Appendix 2 therefore describes the doctor whose contribution to undergraduate education we now discuss. Some of his characteristics are shared with other doctors, some are his alone. Undergraduate medical education in European countries This does not at present have the same aim in all countries. The main differences are between those countries which are producing a "basic doctor" during this period and those which are producing a doctor who is supposed to be competent to practice as a general practitioner soon after he has qualified. A "basic doctor" is one who at qualification has received a general medical education, but is not yet trained to undertake full responsibility in any particular branch of the profession. He will require further specific training, therefore, for every branch, including general practice. The working party hopes and expects that all medical schools will aim to produce a ((basic doctor)~ and that, after this is done, the specific training of a general practitioner will follow and that this will be obligatory. The general practitioner himself will be crucial as a trainer throughout this later stage. Why the general practitioner's contribution is needed Whichever of these two purposes is pursued by a medical school, the contribution of general practitioners also to undergraduate education should always be required, for the following reasons: 1. Medical students need to see and understand the way in which most of the population receive medical care for most of the time they are in contact with medical services. Training confined to hospital patients provides a selected experience, which does not properly represent the wide range of problems presented to medical services. The World Health Organisation (1) has recommended that at each university every medical student should have the chance to see the general practice of medicine, not only theoretically, but practically too, irrespective of his future career. He will gain understanding of problems which are of major importance in themselves and which are not merely variants or minor sub-divisions of the problems raised in hospital practice. 2. They need to see medicine in its most integrated form. This is best demonstrated in the setting of general practice, which is not just an aggregate of all the other specialties of medicine; it can reinforce their teaching and put them into an overall perspective. 3. The process of medical education seems to make students more sensitive to the case than to the person, starting as it does in most schools from a first experience of man as a dead body for anatomical dissection (2-6). It too often leads them to regard knowledge as an end in itself rather than as something to be used, so that the patient will be expected to conform to certain concepts and rules through neglect of the realities which are there to be seen and heard. Contemporary medical education also seems to encourage them to use elaborate technical means rather than to rely in the first place on basic clinical methods. As this document will show, general practice offers a fundamental contribution which counters each of these trends. Its use as a teaching setting is now an effective reality in several European countries. 4. Since general practitioners form the largest single group in the profession in most European countries, and in view of what has been said above about their role, it is likely that more students will continue to enter this branch than any other. For them a preparatory step is needed which will lead naturally to special training after qualification (it is neither desirable nor possible to provide a full training for general practice in the undergraduate curriculum). Students who are going to become surgeons, psychiatrists, pathologists, for example, will have no other chance to see medicine as it is practiced outside hospital, general practice in particular. This matters, since they will act as consultants to general practitioners in their life-long roles and need to understand the specific possibilities of general practitioner care. There are still some countries where specialists are directly accessible to patients, as well as seng them by referral from general practitioners. Direct experience of general practice during the undergraduate period will demonstrate the advantages of the specialist referring the patient to a general practitioner if he or she is to get the full benefit of medical care. 5. Medical students should have a chance to see general practice as one of many career choices. Since students tend to idealise and model themselves on their teachers, it is essential that the model of the good general practitioner should be before them, alongside that of any specialist, and that this model should be seen to be equally acceptable in the medical school. The fact that general practitioners present a model with wide variations will emphasise that what matters is not only what a doctor knows, but what he is. 6. The participation of general practitioners in undergraduate teaching provides the medical school with a new resource, both for teaching and for research. It widens the horizons of the school by involving it more intimately with the community which it serves and keeping it in closer contact with the ever changing needs of the population for medical care. The curriculum can thus be shaped more appropriately. 7. General practice needs the stimulation which belongs to the teaching of undergraduates, just as much as the other branches of the profession need this. The nature of the general practitioner's contribution We describe here the general practitioner's contribution so as to show what it can offer within either of the main types of undergraduate course. Every item has already been used in some European medical school; it is unlikely that any is already using all. It will be clear, we hope, that this can be a large contribution, not only suitable for inclusion at a particular stage, but capable also of being interspersed and interwoven with the course as a whole.
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